The Story of Lalitha: “first she couldn’t swallow, then she had no food to eat”

“He brought them out of darkness and gloom, and broke their bonds asunder” (Psalm 107:14)

May 1990

Lalitha was a 29 year old spinster, the only child in the family living with her mother Somawathie, a rubber tapper earning a daily wage. Following an argument Lalitha tried to commit suicide by swallowing Acetic acid (referred to as rubber acid by those in that occupation and usually kept in their homes. It is used to coagulate the latex). This dangerous incident took place in May 1990 at their home in Ingiriya.  She collapsed with acute chest pain and was rushed to the nearby District Hospital. After initial care she was transferred to a “Bigger” hospital further away and spent two months there with her mother by her side. At that stage she could not swallow and hence was referred to a Thoracic Unit of a General Hospital. She was diagnosed to have a stricture (narrowing) of the gullet. According to Lalitha attempts had been made on 48 occasions to stretch the narrowed gullet so that she could swallow her food. This procedure in surgical terms is referred to as Oesophagoscopy and dilatation of the oesophagus (gullet). Mind you on each occasion she had to undergo general anaesthesia and this procedure was spread over a period of eight years. On every occasion she had some relief of her symptoms but not complete cure of her problem.

October 1998

I first met Lalitha in October 1998 when she was referred from that hospital to my Unit at the Sri Jayewardenapura General Hospital (SJGH). She was 37 years of age. Her body showed signs of wasting and was looking ill at the time of her admission to the ward. Lalitha’s main complaint was that she had difficulty in swallowing and could take only liquids, that too only a trickle at a time. A pathetic situation indeed as her body was wasting away slowly but surely.

What had happened?

Swallowing Acetic acid leads to a burn injury of the gullet (the passage that takes food from the throat to the stomach). This causes acute chest pain and shock immediately afterwards. After the initial burn injury heals the gullet becomes narrow gradually due to contraction of the scar tissue. The narrowing of the gullet leads to the difficulty in swallowing food and drink. This in turn leads to a multitude of problems such as dehydration, anaemia, malnutrition and finally the body withers away leading to death unless major reconstructive surgery is carried out to remove and replace the burnt gullet with another part of the bowel enabling her to take food in a satisfactory manner.

Lalitha had a blocked gullet- she could not swallow

Lalitha was in a desperate situation as she had suffered with difficulty in swallowing for eight years. Initial investigations carried out in my unit revealed that her gullet was so narrow that nothing would pass through that passage. However it would have been a surgical disaster if I attempted corrective surgery without improving her general condition and the associated malnutrition, anaemia etc.

Initial care

This is a very important aspect in the management of such patients. That is to correct her dehydration, anaemia and malnutrition etc. There was no way of doing this part of the management by giving her nutritious food through the normal route as it was completely blocked. It was not even possible to pass a tube through her nose via the gullet (nasogastric tube) into the stomach. Thus we had to think of another way. She underwent a minor surgical procedure where a tube was inserted to a loop of the small intestine. This is called a Jejunostomy. This allowed us to feed her with high energy, protein rich liquids and provide all the nutrients to correct her nutritional deficiencies. This process went on for three months, by which time   she was in a good physical and mental condition to undergo a major surgical procedure.

Lalitha undergoes major reconstructive surgery

Lalitha underwent a major surgical procedure which lasted 8 hours. The gullet that was burnt and scarred was completely removed by an approach through the neck and the abdomen without opening the chest where the gullet is situated. This procedure is referred to as “Transhiatal Blunt Oesophagectomy” (TBO).  Next a segment of the large bowel with its blood supply was prepared. This segment was taken through the chest and placed in the normal site of the gullet and was used to bridge the gap. This was connected at the top end to the Pharynx (throat) and at the bottom end to the stomach.

 This will now act as the conduit to convey food from the pharynx to the stomach. After a few days in the Intensive care she was managed in the ward. Feeding was introduced gradually after two weeks, liquids first, followed by semisolids and thereafter solids like rice. She spent nearly a month in the ward and on discharge was able to take food through the normal route although slowly and in small quantities at a time. Lalitha survived and went home happily as she was able to swallow food and drink once again. She was advised to attend the clinic on a regular basis but defaulted on many occasions for various socio-economic reasons.

Lonely Lalitha Marries Chathupala – 2006 (I am not invited)

After recovery from the operation she continued to live with her mother until her mother’s demise. Loneliness set in as expected. She had no income as well. Lalitha who was 45 years then met and married Chathupala a 61 year old rubber tapper living in the vicinity. That was in 2006 eight years after the major operation. One year later she gave birth to their only son Kumuditha.  To my surprise, suddenly she appeared at the clinic one day carrying baby Kmuditha in her arms.

Lalitha seeks Financial Assistance

She was well, but the reason for her visiting the clinic was to obtain some financial assistance from me to buy milk for her baby boy and some vitamins for her. Lalitha used to visit my clinic whenever she was in a desperate financial situation. Chatupala had no permanent job and used to earn Rs 300/= per day on and off. That was barely sufficient for their sustenance especially with a small child. I used to help her in a small way every time she visited the clinic. That gave her confidence and strength to carry on. I retired from service in October 2014 and after that she could not find me at the clinic anymore.  I too lost contact with her.

Lalith establishes contact with me once again in 2017

Three years later in a state of desperation Lalitha had visited the ward where she was treated in at SJGH. Lalitha was well known to the staff and obtained my phone number from one of them. Thus Lalitha was able to establish contact with me once again. She started calling me regularly to inform me of the difficult situation that she, Chathupala and the boy were going through because of a lack of a regular source of income. Chathupala had no regular income and the so called “Samurdhi” benefit for the poor of Rs 2000/= was not forthcoming on a regular basis. I too became desperate as I could not do much just by answering her telephone calls. I realised that the situation was critical and something had to be done to take this family out of poverty and hunger. I took it upon myself to do the needful before it was too late. I had to act fast. I realised that “those calls were coming to me from the Almighty up there” and could not be ignored.

I travel the extra mile in October 2017

I obtained her address and the directions to her house and informed her that I will be visiting her. The entire family was happy. Their house was in a place called Handapangoda on the Meepe- Ingiriya road about 40 km from my residence. As it was difficult for me to locate the residence Lalitha met me at a certain junction on the main road. She got into my car and directed me and we travelled about 2 km. That was all we could go. The next part of the journey was by foot, trekking through a narrow winding and hilly path across a rubber estate to reach the house on top of an isolated hillock.  It was a sad plight at first site. In fact the construction of the house was incomplete and the inside of it was so dark and like a “dungeon”.  They were certainly living in darkness.  I spoke with them regarding their problems. They faced plenty of problems all connected to poverty and the lack of a regular income. I departed promising to help the family come out of the dark situation they were facing.

Promise fulfilled with help from generous donors

On my way back home I was thinking how I can help this family to come out of their problems and live happily. I drafted a letter titled “The Story of Lalitha: plea for help” indicating the difficulties faced by this family and sent it across by e-mail to many friends, relations and a few organisations.  I also published a small letter in the daily newspaper. There was a tremendous response. Even people I had never met before some living overseas chipped in with their donations. This shows the generosity of our people – “ask and you shall receive.” Some even visited the family in their humble home with “goodies” and cash. That gave them tremendous happiness because they were gradually coming out of their loneliness.

What next

I opened a joint saving account to deposit the funds received. Lalitha too was advised to open a savings account at a nearby bank. Some donors deposited the money directly to her account. After I had received a substantial sum I visited their home and decided on the changes, repairs that were required. With the help of a local contractor all the changes were carried out. I also supplied additional items of furniture, a water tank and a few more electric bulbs to give additional light. Lalitha and her son used to walk two Km daily to reach the main road to get a bus to school. A school van was arranged to take the boy to school. Additional classes in English, Maths and IT were also arranged so that Kumuditha will receive a sound education. Every month Lalitha receives Rs 15,000/= sometimes more for their daily expenses including medicines. This is by way of a standing order from the joint account to her local account. A phone and a small LED Television was also provided. Now they are happy and smiling thanks to all the generous donors who contributed magnanimously. Some continue their support to date.

Lalitha and family invited for a Christmas meal at home – December 2018

I invited the entire family to lunch at my residence on 26^th December 2018 to have lunch with my family members and a few others as well.  Chatupala could not attend. It was happy day for them. They not only met my family members but Kumuditha was also able to play with my grandchildren.

In touch with me regularly

Now Lalitha and Kumuditha contact me regularly by phone. Kumuditha in fact contacts me on Whatsapp using his Smart phone which I bought for him from the funds received from donors.  This was necessitated by the fact that with the closure of the schools all the lessons were taught on line.

After each telephone conversation the parting words are “Sir we are happy now, May God Bless You and Your family”. When are you coming to see us again?

Dear Reader, A very scary and hairy story where very few of these cases are recorded around the world : ‘HAIR SCARE’